Angioplasty is now recognized as a highly valuable method for curing stenosis and other luminal diseases of the vascular system.
However, this technique, although quite appreciated and constantly improved, is not yet systematically used for treating each type of such diseases.
In particular, the brain is a critical area, where vessels are very thin and where even short occlusions could lead to irreversible damages for the patient.
Vessels near the brain, for instance, the carotid bifurcation, should be treated with high care because incident epiphenomena that could be considered minor in other places could have disastrous consequences for the patient when present in such vessels. The circulation of blood should not be interrupted so as to avoid serious consequences, due to the lack of oxygen in the brain. It is generally understood that circulation may not be interrupted for more than a couple of minutes.
The carotid and the carotid bifurcation are furthermore, from a mechanical point of view, critical parts of the body.
The carotid bifurcation has a specific shape (including a segment of widened then restricted cross-section), which is known to provoke turbulences in the blood flow, leading to high local solicitation of the artery walls. As a consequence, stenosis problems are rather frequent in carotids.
A specific problem which occurs in treatment of stenosis in the inner carotid by angioplasty is the evacuation of debris that accumulate in the stenosis. After the stenosis is cured, the debris is naturally carried by the flowing blood. Hence, there is a strong risk that the debris can be transported downstream to the lesion into capillary arteries that they could block, causing thrombosis with catastrophic embolization.
The carotid is considered by some physicians as the last frontier for endovascular therapy. There is still at present considerable scepticism regarding angioplasty in the carotid.